The Psychiatric clinics of North America
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Psychiatr. Clin. North Am. · Dec 2002
ReviewThe autistic spectrum: subgroups, boundaries, and treatment.
There is consensus about the disorders that comprise the autistic spectrum, with autistic disorder, Asperger's disorder, and PDD-NOS as the most typical examples and Rett's disorder and disintegrative disorder as the other components. Important controversies regarding the precise definitions of autistic spectrum disorders and the boundaries between the milder manifestations of those disorders, particularly PDD-NOS, and non-autistic conditions have not been and cannot be resolved fully as long as there is no known biologic cause or consistent biologic or psychological marker. This includes issues as basic as whether the autistic spectrum is a predominantly unitary entity or a collection of more or less similar phenotypes with multiple, varying etiologies. ⋯ For example, there may be good scientific reasons for a narrowly defined categorical diagnosis that includes only individuals who definitely and clearly have a specifically defined condition and excludes individuals who may have the condition. For clinicians and educators, classification helps guide the selection of treatments for an individual. From this point of view, broader diagnostic concepts may be most appropriate [95].
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There are many tasks ahead in the area of ethics and mental illness research. We face unknown challenges in psychiatric genetics projects, studies of psychopharmacological interventions in children, controversial scientific designs (e.g., symptom challenge, medication-free interval), and cross-disciplinary research incorporating goals and methods of health services, epidemiology, and social and behavioral science endeavors. Boundaries between innovative clinical practices and research-related experimentation will become increasingly difficult to distinguish, as will the roles between clinicians, clinical researchers, and basic scientists. ⋯ The profession of psychiatry is poised to move toward a new, more coherent research ethics paradigm in which scientific and ethical issues are recognized as inextricably linked: science as a human activity carries complex ethical meanings and responsibilities, and ethics itself is subject to scrutiny and amenable to scientific inquiry. Building a broader, more versatile, and more effective repertoire of safeguards will be increasingly important, and safeguards, in this view, represent a modest price for the privilege of studying serious illnesses--diseases that cause grave suffering and yet are a source of both vulnerability and strength. In this paradigm, attention to ethics safeguards is no longer understood as a barrier to scientific advancement, but rather as the means by which psychiatric research may be conducted with broad societal support, honorably and, ultimately, with the expectation of bringing benefit to millions of people with mental illness.
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Psychiatr. Clin. North Am. · Sep 2002
The ethical and legal implications of Jaffee v Redmond and the HIPAA medical privacy rule for psychotherapy and general psychiatry.
The 1996 Jaffee v Redmond US Supreme Court decision established a privilege for psychotherapeutic communications in the federal courts. The new privilege has both substantive and symbolic importance. ⋯ The new Health Insurance Portability and Accountability Act (HIPAA) medical privacy rule promulgated by the Department of Health and Human Services relies on Jaffee v Redmond in providing additional legal protections for confidential psychotherapy. Both the US Supreme Court's Jaffee v Redmond ruling and the HIPAA rule support the ethical protection of confidentiality of conversations between psychiatrists and patients.
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Psychiatr. Clin. North Am. · Sep 2002
Non-sexual boundary crossings and boundary violations: the ethical dimension.
The ethical principles relative to nonsexual boundary issues derive from the first principle of respect for the dignity of the patient. Using a case vignette, the authors have explored the mutual derivation and inter-relations of these principles, with clinical approaches to patient care. Clinicians should be aware of the ethical underpinnings of sound therapeutic techniques that manifest respect for the patient.
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In this essay, the author has focused on the rationale for an absolute prohibition of sexual contact between psychiatrists and former patients. The role of an ethics code is to proscribe professional misconduct that may have the potential to harm the patient. Because we know that in many cases of psychiatrist-patient sex there is serious exploitation of the patient's vulnerability, we have clear prohibitions against sexual relations between a current patient and his or her psychiatrist. ⋯ The possibility of a future sexual affair between psychiatrist and patient erodes the conditions necessary for effective psychiatric therapy. Finally, most patients will feel the need to return to treatment at some point in the future, and the psychiatrist needs to preserve that potential as part of the duty to the patient. For all of these reasons, the current position of the APA on an absolute prohibition against sex with former patients is a sound and sensible one.